Overweight: is there a population solution?

First, let me be bold and honest. The answer to the question is “No”. Not while we live in an affluent democracy with abundant, relatively cheap food. You may have your own idea for a solution. Certainly there have been many espoused – tax cakes, confectionery and soft drinks, tax fat people, ban advertising of foods you perceive to be evil or just plain ban every processed food. Simple. It seems that we favour controlling the environment to educating and encouraging people to eat intelligently. The public weight loss campaign is a favourite solution offered by governments.

  

Does anyone listen & act?

Obesity Reviews published a paper that considered 60 interventions or policy proposals since 1980. Although presumed to be useful, may public campaigns have uncertain benefits and, indeed, many aren’t even evaluated for effectiveness. The [http://www.drawthelinewa.com.au/ last Australian campaign] showed 55% awareness among adults. So what? I’m aware of many things too but do stuff-all about it. I know I should turn off appliances and not always have them on standby like I do. I know Mugabe is not good for Zimbabwe but haven’t got around to assassinating him. Evaluating awareness and asking people questions about their intentions is irrelevant to success or failure.

The review also suggests that there can be unintentional consequences, such as some adopting unhealthy diet practices to achieve a goal weight. The Singaporean Trim and Fit program was criticised because it might contribute to eating disorders.

Stigmatised sub-class

Being fat is stigmatised, linked to stereotypes of stupidity, ugliness, weakness and laziness. I would imagine that every campaign directed at their weight can’t make them feel better about themselves. In 2008 it was reported that the US state of Mississippi planned to [http://www.telegraph.co.uk/news/worldnews/1577463/Ban-restaurants-from-serving-obese-people.html ban fat people from restaurants], presumably to keep them away from temptation. Bet that would have been helpful. Is this form of discrimination healthy? Should we fire health professionals, airline staff, police or firemen once they are judged to be fat? For some, I would say “Yes”. A 140kg fireman may be a risk to himself. Yet an overweight dietitian may be a more credible voice about healthy eating than one that can barely throw a shadow.

The review argues that public campaigns focus solely on the kilojoule and health benefits of foods and completely forget the social context of food. If you are told to cut out cheese and wine would you be welcome at your grandparents who left Italy in the 1950s to start life in your country? I now refuse to do media interviews about what to eat over Christmas. Hey, no-one listened in the 1980s, the 90s and frankly I no longer care what you eat for Christmas. Overindulge like most do, enjoy it and do some activity to balance things out.

Responsibility

Although I feel that it is my responsibility, and mine alone, to look after my weight and health, not everyone has that capability. If you are unemployed, have a lousy job, live in a threatening household, hospitalised with a severe injury, feel alienated, or can’t speak the local language then I suspect that looking lean may not be a priority; may not even be on the first two pages of your priority list. I doubt if a weight loss campaign offers them anything more than guilt.

Public weight campaigns have a shot-gun strategy – send out a few messages and hope some will stick. That makes them ineffective. The last Australian public weight loss campaign cost you $45 million, a lot of it on commercial TV. There has to be a better use of the money. That campaign is being written up for a science publication. Hopefully the data will prove me wrong.

It has been suggested that we reward “good behaviour” and give bonuses for weight loss such as the police in one Mexican city who received 100 pesos bonus for every kilo they lost. How would you feel if you were a lean local and heard about that? I would gain a kilo in December, lose it in January, gain it back in February, on and on. Nice little earner. Healthy?

What does it all mean?

Frankly, I think you can have any viewpoint on a population solution to overweight, and justify it however you want, but you would be hard-pressed to show that it was effective, and by that I mean effective in permanently changing eating or activity habits to create weight loss in more than, say, 2% of the population over a five year span.

I’d love to see the stairs full of people and the escalator used by only those over 90, parents carting young children or those recovering from a sports injury. I would also love to see people encouraged to eat well for their health, well-being and longevity while never once mentioning their weight. Public health campaigns should be about health, fitness and well-being. Forget weight – too difficult, too dangerous and nobody listens.

Reference: Obesity Reviews 2011; 12: 669-679

Colon Cleansing

We are fascinated by our bowels. Indeed, they dictate so much. If they work as they should, the world is perfect. If they start creating havoc, it is best to stay at home. A normal functioning intestinal system should be appreciated. It has taken a great-tasting meal, liquefied it, mixed it with enzymes, then gently extracted nutrients and bio-active compounds that nourish us and complement our immune system to keep evil bugs at bay. The fibre does an excellent job of protecting the bowel lining for year on year.

I suspect that as the end result doesn’t look pleasant or smell like perfume there is an assumption that there is a problem. Food does not rot or decompose within you. The colon is not a toxic waste dump. It is a brilliantly designed waste disposal system. Even diarrhea is good for you; it is usually a rapid expulsion of pathogenic bacteria (think food poisoning). It doesn’t feel good at the time, but diarrhea will often save your life. Vomiting is good for the same reason.

Long history

The concept of colon cleansing was based on the assumption that disease resided or originated the bowel. Ancient Egyptians and Greeks had the idea that food was decomposing at the back end and clean-out would help. Early in the 20^th century washing out the colon with large volumes of fluid was a popular therapy. Despite our excellent knowledge of digestion, some think that this most strange of activities still offers merit in the 21^st century.

Unpleasant side effects

A review article detailed a couple of cases where colon cleansing (or colonic irrigation) caused medical problems of intestinal pain and diarrhea. Some people receive up to 60 litres of water, with or without herbs, coffee and so-called “natural” ingredients.

The authors point that those likely to request colon cleansing may have medical problems like Crohn’s disease and haemorrhoids, and are more likely to experience adverse effects with this uncomfortable practice. Even if you are reasonably healthy, you can get side effects like nausea, vomiting, diarrhea, dehydration, pancreatitis, bowel perforation and infection from colon cleansing.

What does it all mean?

Of course, sometimes a bowel washout is necessary for medical examinations or surgery such as that for colon cancer. For the rest of us, know that your bowels don’t require some liquid intervention. Apart from the discomfort and there not being a shred of evidence for a health benefit, you will be washing out all those healthy bacteria that produce nutrients for your body and compounds that protect the bowel lining. Your body already has a natural detoxification system – the liver, kidneys, lungs and the intestines detoxify you in perfect harmony while you enjoy life.

Don’t engage in colon cleansing. Other forms of madness are far more healthy, like supporting the Fremantle Dockers football team, wearing ugg boots and eating alone in restuarants.

Reference: Journal of Family Practice 2011; 60 (8): 454-457

Eating alone

Because I am responsible for some research at the University of Western Sydney, 2-3 times a year I fly 4000 km to Sydney, then catch a train out to Parramatta in the deep western suburbs of the city. On arrival I dump my kit and head down to the sushi bar or Vietnamese restaurant for dinner. I sit there on my lonesome, eat and read (see pic).

I get sad looks and people comment that they hope to never end up like me, you know, kicked out of home, no friends, a person of interest to the local police.

Read, listen, type

Past research suggests that if you eat with friends then you are likely to eat more food, probably because you chat longer, drink more and eating is a social occasion so why not enjoy a second helping or some dessert? How much more? I’ve seen research ranging from 25% more to 100% more.

Research from the 1990s also found that lone diners who read seemed to stay at the meal table for longer. They didn’t record how much was eaten.

A study conducted in South Australia wanted to see if more food was eaten when someone ate alone while reading, listening to an ipod or using a laptop at the table. These people were labeled with the crushing expression “without social interaction”.

30 minutes

The observations were done at McDonalds in Adelaide because a Maccas menu is standardised and it easier to determine how much is eaten than at my sushi bar. Someone secretly watched all diners and recorded 141 people having no social interaction. They couldn’t include drinks because a secret observer can’t tell the difference between diet or regular drinks. The meals chosen by the observed lasted from 2-44 minutes, with half an hour being the average.

Music, typing, books didn’t increase eating

If you read, typed or tuned into your own music then you stayed longer, especially if you read. Thankfully, reading didn’t mean that you ate more. You spent twice as long at the table, but you didn’t eat more. Only one of those 141 diners went back for extra food. The researchers speculated that eating with others stimulated other social eating dimensions encouraging people to eat more; the mere presence of food didn’t drive people to over-eat. Reading while eating may have done no more than to reduce the discomfort of eating alone.

What does it all mean?

If you find yourself eating alone and happy to catch up on emails, tweet, read a novel or chill to some garage rock (my favourite) then ignore the looks of those thinking that you are tomorrow’s front page news. Just choose your meal wisely and enjoy it. It’s unlikely you are going to overdo it.

Every now and again have a look around. That dodgy bloke in the corner with the note pad and the camera stuffed under the jacket could be from the local university. Pop over and tell them that laptopping, ipodding and reading is a form of social interaction; just because I’m not talking doesn’t mean I ain’t interacting with society. Hey, aren’t I interacting with you right now? Hope you’ve enjoyed it as much as I have. Seriously.

Reference:  Appetite 2011; 57: 77-79

Chewing gum

It seems mandatory that every soccer boss chews gum during the match. Maybe it helps to control the nerves. Or maybe it is based on decade-old research suggesting it sharpens the brain.

Chewing gum fits into the “feels good, looks ugly” category. I’ve seen presenters chew gum as they talk, giving the occasional flash of white blob. Kind of distracts from the message they offer.

  

Teeth, heartburn and your brain

Forget looks. What does the research tell us, because we always love it when someone applies a bit of science to a common pastime?

A small study back in 2005 revealed that chewing gum can ease symptoms of heartburn, probably due to the swallowed saliva buffering stomach acid, and because chewing quickens the emptying of the stomach.

We know that the saliva production stimulated by sugar-free gum chewing helps protect the teeth from decay after a meal. The action of munching away on gum also increases blood flow to the forebrain by 25%. Does that mean that extra glucose is being transported to the frontal cortex, helping memory and thinking? Initially it was thought so.

Thinking & memory

More recently, college undergraduates underwent a series of cognitive tests after they had either chewed gum or had nothing to chew. The gum chewers did better on word recall and speed of mental processing. The greatest advantage in chewing gum for five minutes before the test was in the first 20 minutes or so of testing, after which the test results tended to even up.

Before, not during

The researchers acknowledge that there is other research showing little mental benefit for chewing gum, but this has been in studies where gum was chewed during the tests. In this study, when the gum was chewed and spat out before the tests started, the participants did well; when the gum was chewed during the tests they did no better than the non-chewers.

The authors state: “Clear performance advantages emerge when gum is chewed prior to (but not during) cognitive testing, although the benefits persist only for the first 15-20 minutes of the testing session.”

What does it all mean?

First, please don’t chew gum as you present to an audience. I don’t need to see that bolus circumnavigating your gob. Now, if you have a tricky problem to solve, maybe reaching into the pocket for a sick of gum could help you find a resolution. Just remember to chew for five minutes and then discard the gum into a bin before you face the problem. To help keep your fangs healthy, then it makes sense to choose sugar-free versions of gum.

Recently I was given a sugar-free gum that was impregnated with calcium. If they promise to advertise in my newsletter, I’ll tell you the name. Oh, OK it was Extra Professional with about 40mg calcium per tablet (you need about 1000mg of calcium a day for solid bones). It’s relatively new to Australia and New Zealand, although it could have been around a long time near you.

Reference: Appetite 2011; 57: 321-328

Carbohydrate blockers

Hi Glenn,

Thank you for your newsletters. I always find your information up to date and interesting, and so relevant to everyday life.

I work in a gym and have a patron whose latest questions are all about products that inhibit the uptake of carbohydrates.

He has asked about white kidney bean extract – “I’m going to use it in my next cutting phase, so I’m wondering what is the best way to use it? Eat white kidney beans? Or buy a supplement/pill?”

He has also asked about the product C-plex 60 which claims to reduce carbohydrate absorption by over 80%.

I am sceptical about these products but the individual seems hell bent on trying to convince me that they are legitimate.

Many thanks,

Georgie Feakes

Thanks for your note Georgie.

Be aware that if someone has a deep belief then nothing you or I will say will make a difference.

Also be aware that anything that causes significant carbohydrate malabsorption will also cause severe gut pain, gas and diarrhea. The gut was designed to digest and absorb food. Stopping that function is unnatural and the body will react in a very uncomfortable fashion. There is no way a product will reduce carbohydrate absorption by 80%. If it did, then you would be in hospital.

Some products may cause a very small amount of carbohydrate malabsorption. There is evidence that the white kidney bean extract you mention does encourage weight loss], in the region of 1kg per month, through inhibiting some carbohydrate digestion. I would argue "Why not eat a little less instead. Cheaper, easier and probably more effective".

Get educated (Perth, Western Australia)

Once again, for those of you living Perth, Western Australia, I shall be running two different nutrition courses for the University of Western Australia Extension Program. The first is an honest, sometimes quirky, seminar on living for long life. The link for this course is here.

For the first time at the university I shall also be running a very practical course on nutrition for sports performance. There is more here. Whether you are building up to your first 10 km run or if you are a long-course triathlete there will be something here to improve your sports performance.

Love to see your face.

When the gavel falls

There you are, waiting the decision. You’ve done the crime and you’ve done the time. Now you reckon you should be released from prison so you can start life afresh. The judge reads the report, listens to your arguments for release and makes the decision: you are to remain in prison. Not what you wanted to hear. The judge then calls for a recess and heads off to morning tea.

It is all about timing

What you experienced was probably more a case of bad timing than a poor argument on your part. There is a saying that a decision often “depends upon what the judge had for breakfast.” Research on over a thousand parole decisions agrees. Judges make decisions more likely to favour a prisoner if the judge has just returned from a meal or a break. And the difference is significant.

No chance just before lunch

At the start of the morning or just after a food break, around two thirds of prisoners got a favourable parole decision. By the end of the session, with the judge due for a meal or a break, virtually no prisoners heard the words they wanted to hear. The researchers state: “the percentage of favourable rulings drops gradually from 65% to nearly zero within each decision session and returns abruptly to 65% after a break.”

Food and a rest is the key

Naturally, the researchers looked at other factors that could be playing a role. Did the better class of prisoner come in near the start of a session? No. Did the judges know each case before they appeared and scheduled a break after a couple of tough prisoners? No. The truth is that it was an entirely random process. It all came down to how well fed and refreshed the judge was. How’s that for justice?

What does it all mean?

This research has much broader implications. I used to mark university student assignments. The best I could do was 15 at a time. By the time I got to #12 my brain was beginning to disintegrate. I’m sure the last 3-4 in a marking session got lower marks because my brain was fried. What if you are the last person to be interviewed for a job? Have you got the same chance as the first two?

And then think about what you do during the day. Would you and your thinking benefit from more breaks? Did you eat breakfast? If you did, we know from other research that you will likely be thinking better and making wiser decisions.

And if you ever have to front up to court make sure you take some fruit to offer the judge because if it is coming up to his/her lunch break it could save you a lot of grief.

Reference: 

Proceedings of the National Academy of Sciences 2011; 108 (17): 6889-6892